Does Insurance Cover Stem Cell Procedures?

by Tom Streissguth

Stem-cell therapy is available for a limited number of illnesses.

New medical therapies using stem cells offer some hope of treatment for illness and injury. Stem cells are those that are not yet designed for a specific purpose in the body; they are potentially capable of repairing and regenerating the body's damaged organs and tissue. Several private clinics offer stem cell therapy for a wide variety of health problems, and health labs around the world are conducting clinical trials. Insurance companies, however, will only cover procedures they consider routine and essential.

Adult Stem Cells

Most stem cell therapy involves the use of adult stem cells harvested from your own body. This "autologous" transplant is not the same as "embryonic" stem cell therapy, which relies on stem cells taken from a fetus or through in-vitro fertilization. By using a patient's own cells, doctors avoid the possible "immunogenic" rejection by the body of a foreign substance. Medical researchers have developed stem-cell therapies for heart disease, cancer, diabetes, arthritis and chronic obstructive pulmonary disorder, among other illnesses.

Insurance Coverage

Stem-cell therapy is a relatively new medical procedure. Although it has become widely accepted in association with chemotherapy for non-Hodgkin's lymphoma and other disorders, the applications are still limited. Insurance companies will not reimburse you for the cost of procedures considered "experimental," nor will they offer stem-cell therapy coverage as a rider (addition) to your existing policy.

Clinical Trials

Without insurance coverage, the cost of stem-cell treatment must be borne by the patient; one exception to this general rule would be a clinical trial, which is by definition experimental. Legitimate research studies must have independent oversight, meaning a panel of experts reviews the procedures for safety, as well as approval by a regulatory agency such as the Food and Drug Administration. A research organization, government agency or private company underwrites the cost of the trial, meaning no charge to the subjects.

Coverage Limits

The cost of autologous stem-cell transplants can exceed $100,000, in addition to the cost of an extended stay in the hospital. Because this treatment has become widely accepted for some illnesses, your insurance may cover it if it's not considered experimental. There may still be co-pays and deductible amounts involved, and your insurance company may not cover treatment by a doctor or clinic outside of their provider network (which would include foreign clinics and hospitals). As for any major procedure, you must request a review and pre-approval of coverage from the insurance company before undergoing stem-cell therapy, if you're seeking reimbursement.